The government of Jamaica has asked the United States health sector to cease the poaching of its nurses. “Jamaica Says to Stop Poaching Our Nurses” was a report on National Public Radio earlier this year based on an interview with Mr. James Moss-Solomon, the chairman of the University Hospital of the West Indies in Kingston. He likened the situation to a crisis.
The exodus has forced Jamaican hospitals to reschedule some complex surgeries because of a lack of nursing staff on their floors, according to the report. Moss-Solomon says the United States, Canada, and the United Kingdom are, in his words, “poaching” Jamaica’s most critical nurses. “Specialist nurses is the problem. We have tons of regular nurses,” he told NPR. He was talking about nurses trained to work in such settings as intensive care units, oncology, infectious disease, operating rooms, and emergency rooms. They are the ones being lured away and their English language skills heighten their appeal. “We do very well training our specialist nurses here at a fraction of the cost of what it costs you in the United States or Canada or the UK; so, the issue is an economic one for us,” he explains.
In February, as part of the Jamaica Medical Mission, I discussed this issue with Althea Davis, RN, MHA, as I sat with her in a church hall in the city of Port Maria. For 27 years the mission has served the people of Jamaica under the auspices of the St. James Episcopal Church of Leesburg, Florida. The 55 members of the team represented physicians, dentists, hygienists, optometrists, pharmacists, nurses, physician assistants, and support staff. They came from Los Angeles, Ottawa, New York, San Francisco, Maryland, and Florida.
The team brought state-of-the-art health care to the people of that region for eight days and with tremendous energy and dedication delivered competent care to over 1,700 patients, who for the last 5 years have had their medical records computerized and accessible when the team visits.
Davis, a supervisory public health nurse, serves four health districts. “The nurses are expected to provide service in every aspect of care and are held to a very high standard. In the case of the public health nurse, the Jamaican nurses rank among the best worldwide,” she says.
According to Davis, the training model that Jamaica has followed came out of work done back in the 1970’s and is continuously updated. Over time, specialists have been added in areas such as nutrition, health promotion, information technology, and electronic records management, which is intended to provide a more robust care delivery system and improve patient satisfaction. “Because of training provided, we were well prepared to deal with the Ebola outbreak, and the highly contagious Chikungunya virus,” says Davis.
However, Davis quickly hastened to add that the problem facing the nursing sector is that the profession is “under resourced.”
Davis’ conclusion is an echo of Moss-Solomon’s. The skilled staff are stretched. The referral process for advanced treatment that cannot be handled at the nurses’ level is inadequate at best and unavailable at worst. “It is not just the compensation that influences nurses to leave the island,” Davis says. “It’s also the sense that nurses are not accorded the appreciation for what they do even by health care agencies.”
According to the World Bank, “these shortages have tangible impacts that may compromise the ability of English-speaking [Caribbean] countries to meet their key health care service needs, especially in the areas of disease prevention and care. In addition, the shortage of highly trained nurses reduces the capacity of countries to offer quality health care at a time when Caribbean countries aim to attract businesses, visitors and retirees as an important pillar of growth,” the report states.
In Jamaica, about three out of every four nurses trained have migrated to developed countries. But the Jamaican experience is not unique. In the case of the UK, a recent report by the Royal College of Nursing stated that the nursing workforce has moved from a situation of “net inflow of nurses to a position of net outflow in recent years.” This means that more nurses are moving abroad than are coming to the UK to practice. The main destinations are Australia, Canada, New Zealand, and the United States.
The NPR program stated that Jamaica has been offering free training for nurses to get advanced degrees. The nurses agree to work for three or four years in Jamaica in exchange for the heavily-subsidized education. “But U.S. recruiters,” says Moss-Solomon, “simply pay the fine for contract violation and the nurses fly off to lucrative jobs in the U.S.”
Jamaica’s response to these losses? They are bringing 25 nurses from Cuba to help staff some floors and have plans to recruit nurses from India and the Philippines and have recruited nurses from as far away as Burma/Myanmar.
Increased international recruitment of nurses requires that several policy issues be explicitly addressed. The international debate over the responsibilities of recruiting nations toward countries whose nurses are being recruited, many of which are developing countries, necessitates provision of ethical recruitment guidelines and codes of practice inclusive of possible financial compensation for sending countries in the face of a global nurse shortage.
Keondra Rustan, RN, MSN, PhD(c), visiting assistant professor at Linfield College in Portland, OR, has overcome many challenges in her decade-long career as a nurse and nurse educator. Raised in a single-parent home with limited resources, she discovered how she could channel her interest in science into a nursing career by reaching out to mentors along the way.
Today, she shares her story and offers advice to other minority nursing students and nurses who may face similar challenges in their education and careers.
How long have you been in the nursing field and what has been your career history until now?
I have been a nurse for nine and a half years. I started out working in cardiac health care in Virginia. I did cardiac stepdown, some cath lab work, and I floated to some cardiac ICUs. I then went to the ICU where I learned a great deal and developed some professionalism and leadership traits. I then went on to become an assistant manager of an ICU and IMCU. I finished my master’s degree and became a professor at a private college where I rediscovered simulation and developed a great love for it. I became the simulation lab coordinator and for a time was the interim director of the LPN program, and went on to become the assistant director of the LPN program so that I could make more time for my doctoral schooling.
I am currently working in the dissertation phase of my doctoral program and enjoying my work at Linfield College as a visiting assistant professor working in simulation as lead faculty.
What inspired you to enter the nursing profession?
At first I didn’t want to be a nurse. I went through all of my primary schooling without having the decision of wanting to be a nurse. I wanted to be a scientist at first like those scientists in Jurassic Park.
Later on in high school I decided that I wanted to be a scientist that could help cure diseases and study microbes. However, I lost my grandmother when I was in high school and some of the care that she received wasn’t the best and lacked empathy. I decided that I wanted to help people more directly and show them that they aren’t just a room number but a thriving person who was deserving of care. I wanted to be a person who made a difference in the lives of others.
As nurses we often aren’t remembered individually; but if a patient has less exacerbations and starts feeling better because of your care and the education that you provided, it is very rewarding.
What inspired you to become a nurse educator?
I discovered that I liked teaching by precepting new nurses and nursing students. I enjoyed seeing the potential in them. I loved teaching them how to do things based on evidence and why it was so important for it to be done that way. I wanted to show them how to provide holistic care to patients and help them grow into future leaders.
I also enjoyed telling them stories so they could directly apply the teachings to their practice. Most importantly, I wanted them to have things I did not have prior to becoming a nurse: resources and a mentor. I wanted to apply these principles on a broader and larger scale so I went into the field of nurse education.
I would say the first year or so I was not very good at it. Or at least I did not feel as though I was a good teacher. I did not have a mentor or anyone to show me the ropes so I just taught them the way I was thought, which did not work.
What challenges have you faced in your career and how have you overcome them?
In my career my biggest challenges have come from lack of resources and lack of mentors. I grew up in a low-income single parent home with no vehicle. We did not have the funding or access to resources to get informed about career programs while in high school or even most scholarships. I wasn’t aggressive enough in thinking of my future and did not have enough drive when I was younger to seek those resources.
Once I decided to become a nurse, I didn’t really know how to become one, what nurses actually did, and what type of nurse I wanted to be (even when I graduated I still did not know that part). I had a lot of ideas, but I did not know how to bring them into fruition.
I overcame the lack of resources and lack of mentoring by joining organizations (good old-fashion Google search) based on my interests. When I was obtaining my BSN I got accepted into Sigma Theta Tau (the nursing honor society). Going to those conferences really opened a lot of doors for me. I am so grateful for the aid of the nurses and educators that I have met throughout my nursing career. They were able to point me into a lot of great directions. I am still growing and have a great deal more that I want to accomplish.
What challenges do you see minority nursing students face and what is your advice for them?
I see lack of resources as a big one and lack of mentors. Minority students (and I include males in this) have a high risk of falling through the cracks in nursing school. There seems to be a reluctance to seek aid when dealing with difficulties. It is hard to get over, because typically it is culturally ingrained.
My advice is to seek help right away when you are having trouble. If your school does not assign faculty mentors, seek out an instructor that you feel you can connect with. Shadow a nurse if you are not experienced with the duties of a nurse, so you have an idea of if it is right for you. Don’t be afraid to ask for help; if you do not understand, seek help (think of the patient’s safety).
Most nursing schools have scholarships, open labs, writing labs, and tutors available for their students; make use of these resources and give yourself support. View any setback as a learning opportunity and grow from the experience. Never stop learning even after you are licensed and working on the floor. Google search some nursing organizations (you can even join some as a student for a cheaper price) and they can lead you down some interesting paths. Also, once you obtain your knowledge, pass it on. You never know who you will be helping with your expertise and experience.
Where do you see yourself in 5-10 years?
I see myself with at least 10 articles published and maybe a book, of course having obtained my PhD. I want to still be educating nursing students and maybe have obtained my NP. I want to continue to learn and grow each day to become the best educator that I can be. I want to do more in community and be a greater help to those in need.
Marygrace Colucci (center) along with her supervisor/nurse manager Louise Esposito (right) and Marianna Vazquez, CNO (left)
Imagine moving to the United States from the Philippines and building a nursing and military career. That’s what Marygrace Colucci, RN, BSN, MSN, did when she migrated to the U.S. in 1995. Today, Colucci is living her lifelong dream as a staff RN in the ophthalmology operating room at Northwell Health at Syosset Hospital in New Hyde Park, New York.
In May, Colucci was honored with the Zuckerberg Nursing Excellence Award during National Nurses Week. The award recognizes exceptional nurses at Northwell Health.
“Ever since I was a little girl, I wanted to be a nurse,” Colucci says. “I have seven siblings, so my parents could only send me to a two-year midwifery program due to the financial constraint to support a four-year BSN program. I graduated at 18, passed the midwifery board but couldn’t get my license until I was 21 years old. I started working as a midwife in the hospital with just a permit, and I remember having so much fun delivering babies, and assisting in C-section procedures.”
Colucci says that when she first arrived in the U.S., it was a huge culture shock. “I missed my family and friends. I was homesick, but eventually got over it,” she says. “I was afraid to talk to people because of the language barrier; not because I didn’t know how to speak the language, but more because I was shy of my English and my accent.”
Colucci was inspired by her cousin who served in the U.S. Army as a nurse. “He was sort of my role model, and that is why I joined the Army Reserve in 1998,” Colucci says. “Joining the Army helped me overcome most of the challenges I had to face back then such as the language barrier, being shy, and lacking self-confidence. The Army taught me how to face all kinds of adversity. I’d have to say the Army really turned me into the kind of person I am today.”
Another supportive influence for Colucci has been her husband. “When I graduated with my associate’s degree in nursing, he told me I should go back to school, which I intended to do anyway. I went on to finish my BSN, and he told me again that I should go for my master’s, which I intended on doing. But him pushing me to go further was really a good motivator. And now that I’m done with my NP, he said go for your doctorate, which I’m still considering.”
Colucci says for now she is focusing on her military career. She hopes to be promoted to major in the future. “I also want to focus on helping soldiers from my unit, which I am currently commanding,” she says. “I try to motivate my soldiers and tell them that they can do so much with their skills, and that there are so many opportunities available if they’ll just work hard for everything that they want to achieve.”
“I also tell my fellow Filipino coworkers to advance their education by going back to school,” she says. “I told them that if I can do it, so can they. I’m not really smart; I just happen to be disciplined and really put a lot of time and effort into everything I set my mind on achieving.”
Colucci sees herself working in emergency medicine in the future. “I had a great time when I was doing my clinical at the urgent care centers. I told myself I will embark in that field if given the chance. I think emergency medicine is a very good and rewarding field to practice. I would like to be promoted to major in the next two years; and eventually to lieutenant colonel in the Army Nurse Corps.”
Like many minority nurses, Jackie F. Webb, DNP, FNP-BC, RN, associate professor at Linfield College School of Nursing in Portland, Oregon, had to overcome many challenges on her career path to becoming a family nurse practitioner.
Webb is the daughter of immigrants to the United States and is a first-generation college graduate. Her parents worked hard to provide for their family and instilled the importance of going to college. It wasn’t until Webb got a job in a nursing home that she set her sights on becoming a nurse.
“I did not start out college knowing I wanted to be a nurse,” says Webb. “It was the experience of working in a nursing home and meeting an incredible nurse who exposed me to the challenges of nursing that convinced me to major in nursing. Looking back, I realize the time this nurse took to help me see the power and art of nursing, and her support is what gave me the belief I, too, could be a nurse.”
Webb initially thought she wanted to work as a critical care nurse, but soon realized she was most interested in preventing patients from ever needing a critical care unit.
“Working as a public health nurse opened my eyes to the challenges of seeing patients in their own homes, without fancy equipment but my stethoscope and a BP cuff, and my ability to really listen and take a thorough health history.”
This experience motivated Webb to go to graduate school and become a nurse practitioner where she learned how to manage chronic illnesses and how to incorporate cultural beliefs into the patient’s management plans. She has been a family nurse practitioner for more than 30 years.
Like many minority nurses, along the way Webb had several challenges to overcome.
“Not having role models, not having parents who knew how to navigate the world of college applications, finances, scholarships, etc. Additional challenges for me included not having good writing skills, not having a rich vocabulary, and not having experiences like so many of my friends. My parents didn’t take vacations, they didn’t belong to book clubs, they didn’t have dinner parties nor did they have their brothers and sisters or any family member close by. They both had to work long hours to afford a roof over our head. The isolation of being a first-generation immigrant was at times difficult.”
Webb believes that there are ways for colleges and universities to help immigrant and first-generation college students overcome the unique challenges they face.
“Colleges and universities who work with immigrant students and/or first-generation college students need to know that these students are for the most part willing to work harder than any other student population,” says Webb. “For some they see how hard their parents work to just keep food on the table, they don’t take anything for granted. These students are grateful for any type of assistance and will overcome amazing barriers to obtain their college degrees. Many of these students end up inspiring other students and take on challenges many students are fearful to take. Many students value their college community and will take on various leadership roles.”
So what advice would Webb offer to minority nursing students today? “I would tell them to value their personal stories,” says Webb. “Value your history and that of your family. Be proud of the hard work your family has gone through to get to where you are now. The passion, the self-reliance, and support students have will get them very far.
Webb also encourages minority students to reach out for support. “For many students of color they are the first to attend college. This is an incredible journey they are undertaking and they cannot do it alone,” says Webb. “It is so important that they find a mentor or advisor so they can feel comfortable asking how to navigate this new journey. Use every available resource so you are able to be successful. Don’t be afraid, embarrassed, or feel that asking for help is a sign of weakness. I believe it is absolutely the reverse: asking for help is a definite sign of strength as it shows you are ready to do the work.”
Having a strong mentor and academic advisor can make a huge difference in the lives of undergraduate and graduate nursing students. Being that mentor is what motivates Ronald Hickman, PhD, RN, ACNP-BC, FNAP, FAAN, associate professor of nursing at the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland, OH.
Hickman has been honored with two esteemed awards for student mentorship at Case Western Reserve University: the John S. Diekhoff Award for Excellence in Graduate Mentoring, which is presented to four full-time faculty members who make exemplary contributions to the education and development of graduate students; and the J. Bruce Jackson Award for Excellence in Undergraduate Mentoring, which celebrates faculty and staff who have guided a student in their academic and career paths; fostered the student’s long-term personal development; challenged the student to reflect, explore, and grow as an individual; and supported and/or facilitated the student’s goals and life choices.
“Mentoring has been a cornerstone approach to making a difference in the lives of undergraduate and graduate nursing students,” says Hickman. “The receipt of two of the university’s top honors for mentoring undergraduate and graduate students is a testament to my commitment to making sure that I pay it forward.”
Hickman says the mentorship he received across his undergraduate and graduate studies has been invaluable. “My mentors shared their lived experiences and lessons learned to help me avoid pitfalls and inspire me toward a career in academe. These honors highlight my commitment to mentoring and acknowledge the impact of effective mentorship on the lives of emerging leaders in nursing practice and research.”
However, nursing was not Hickman’s original career plan. “As an undergraduate student, I majored in biological sciences with the intention to attend medical school after graduation.”
He was not admitted to medical school, but upon reflection about potential career paths he decided to pursue nursing because it aligned with his personal philosophy of health. “Although nursing was not my first choice for a career, it was the right choice for me,” he says.
Hickman acknowledges that pursing a nursing career can be challenging for minorities.
“Many minority nurses are the first in their families to attend college and are standouts in their communities,” he says. “When entering the nursing profession, the academic preparation is challenging and, in most instances, the diversity of nursing faculty is often not representative. This can create situations where minority nurses do not wish to speak up and seek help when needed. Whether you are pursuing a nursing degree or transitioning to a new role in nursing, do not suffer in silence. Asking for assistance often facilitates your success and delivery of safe nursing care.”
Another key to success that Hickman recommends for minority nursing students is to find a strong mentor and strongly consider pursing a doctoral degree in nursing.
Hickman is truly paying it forward. “As a nurse educator, I am inspired daily by helping students develop as competent nurse clinicians and scientists,” he says. “Helping others achieve their goals is an invaluable and enduring experience for most educators. The opportunity to inspire and challenge future nurse leaders is a priceless reward.”
Hickman sees himself in a senior leadership position in a school or college of nursing in the future. “My aspiration to secure a senior leadership position aligns with my commitment to help an organization and its’ faculty achieve their goals and impact the health of Americans.”
With nursing shortages a pressing issue throughout pockets of the country, one branch of nursing could help remedy the solution, says Marcia Faller, PhD, RN, and chief clinical officer of AMN Healthcare. Travel nurses can fill short-term needs while organizations are able to assess, stabilize, and hire permanent nurses without compromising patient care during a staffing shortage.
Faller says travel nurses can help fill the gaps while providing high-quality, reliable care. She points to a study slated for summer publication in the peer-reviewed journal, Nurse Leader, that reveals that patient outcomes for travel nurses and staff nurses are no different. In fact, the study asserts, travel nurses might help ease the staffing burdens and contribute to less error and nurse burnout. Using data sources from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and National Database of Nursing Quality Indicators™ (NDNQI®), the study looked at a U.S. hospital to assess patient outcomes when using both core nurses and travel nurses.
According to Faller, most travel nurses work in temporary job assignments of three months at a time. After their rotation is done, they might stay for another three months, sign on for a permanent position, or move on to another assignment in a new location.
“It’s very appealing,” says Faller. It’s a quick and easy way to get a new job and gain both professional experience in a new area while also having the chance to travel. Some nurses want to shift their location for a life event—a child is getting married across the country or has a new baby, for instance. Or a nurse from a smaller community might want to gain experience in a larger academic center, Faller says. Maybe they have a list of places they want to see and travel nursing will help them do that while also working at a job they enjoy.
Travel nurses only account for two percent of all nurses, says Faller, but they offer both a distinct nursing career opportunity and a boon for organizations who need more nurses.
Different organizations find travel nurses help their staffing needs in varied ways, says Faller, and help keep the quality of care high. “Travel nurses give them the ability to fill vacancies where they are finding themselves short staffed,” Faller says.
Organizations can fill the positions while continuing to focus on recruiting. Travel nurses are also especially helpful when it comes to covering non-productive hours, says Faller. For instance, known times when nursing staff members are taking PTO, jury duty, has a leave of absence, or even needs educational time off are all good times for travel nurses to fill in. Travel nurses can also help offset overtime costs and hours. “Those have to get covered somehow,” says Faller, and helping ease up on too much staff overtime can also help offset nurse burnout and eventually retain nurses and keep turnover down.
If an organization is launching a new event, like electronic medical records, travel nurses can help cover staffing while regular staff is undergoing training.
And Faller notes that travel nurses are held to the same high standards as staff nurses. They need to have the same credentials as other nurses for whatever location they are going to, she says. And while approximately 25 states are part of the multi-state contract that allows nurses to use one license for many states, the rest of the states do require independent state licenses. Travel nurses also must pass background checks, drug screening, and any other requirements for hiring. And travel nurses are well-educated, she says, with 64 percent of travel nurses having a BSN or higher.
A nurse with a couple of travel experiences under his or her belt has some valuable skills, says Faller. These nurses are adaptive by nature, learning quickly how an operation is run and how to find what they need to do their jobs well.
As the demographics of the country continue to change and become increasingly diverse, travel nurses can help fill a gap and provide a service that many organizations need. Nurses who speak multiple languages or who fit with the cultural background of the patient population being served are especially valuable, says Faller. “There is a large demand for that cultural matching,” she says, noting that even a familiarity with a certain culture can help organizations align with their patient populations in a way that helps everyone.
Whether you are considering travel nursing for a career move or are an administrator assessing the best way to fill in the gaps, travel nursing is an option that’s both viable and valuable.